Modifier Mania
This modifier is only attached to an E/M code and identifies a separately identifiable E/M service.
What is -25?
SDOH is the acronym for this term.
What is Social Determinants of Health?
These are two of the domains impacting quality scores and reimbursement.
What are Clinical Outcomes, Safety, Efficiency & Cost Reduction, Person/Community Engagement (pick 2)?
Outpatient E/M's are leveled using one of these two factors.
What are Medical Decision Making and Time"?
This is the MAC for Alabama
What is Palmetto GBA?
Palmetto GBS recommends not using this modifier.
What is -51?
This level of medical decision making can be demonstrated when SDOH impacts patient care.
What is Moderate?
These are used to risk adjust patient data for MA plans, State Health populations with commercial payers and Medicare spending per beneficiary.
What are HCC's?
These codes includes management on the day of death.
What are 99238, 99239?
The Public Health Emergency is set to end on this date, unless extended again.
What is April 14, 2022?
These types of modifiers should be sequenced first after the CPT/HCPCS.
What are pricing modifiers?
Most patient's SDOH is collected in this manner.
What is self reporting by the patient?
The acronym for this term is HCC.
What is "Hierarchical Condition Categories"?
Prolonged services (99417) for new patients can be billed at this time.
What is 75 minutes?
According to the 2021 CERT Annual Report, this improper payment rate error category had the highest percentage of error.
What is insufficient documentation?
Medicare subjects all charge lines for the same beneficiary, NPI and DOS to these edits.
What are NCCI edits?
These are 3 common SDOH factors that impact care.
What are: hygiene, education, literacy, presence of family/caretakers in the home, discretionary income, housing, physical environment, personal health practices, employment/working conditions, culture, social status or support, access to healthcare (pick 3)?
These are 3 diagnoses that count as risk variables for patients admitted for CABG.
What are: Hx of CABG, CAD, Morbid Obesity, Dementia, Pneumonia, Dialysis Status when documented any visit during previous 12 months
This Care Management Service is focused on a single complex chronic condition expected to last at least 3 months.
What is Principal Care Management?
This is the year the OIG began Medicare Hospital Provider Compliance Reviews.
What is 2011?
What are: Palmetto GBA's modifier look up tool, NCCI edits and the Medicare Physician Fee Schedule database (pick 2).
Genetics only accounts for this percentage of a person's health.
What is 30%?
These 6 measures are included in the HVBP Program.
AMI, CABG, HF, Pneumonia, COPD, Stroke
Split/Shared services have been expanded to include these 2 new areas.
What are NF, SNF, Emergency, New Patients, Initial hospital visits, critical care (pick 2)?
These are the two types of reviews performed by Livanta, the National Medicare Claim Review Contractor.
What are Higher Weighted DRG requests and Short Stay reviews?